Knee Replacement Surgery

Total Knee Replacement

Total knee replacement is one of the most successful procedures in modern orthopaedic surgery. It is designed to relieve pain caused by arthritis and improve knee function, mobility and quality of life.

Chronic knee pain can affect every aspect of daily living, from walking and sleeping to socialising, working and maintaining independence. When knee arthritis limits what you can do despite appropriate non-surgical treatments, total knee replacement may help restore comfort, confidence and movement.

Total knee replacement is usually recommended for patients with:

• End-stage “bone-on-bone” arthritis
• Persistent knee pain that limits daily activities
• Reduced mobility despite physiotherapy, medication or injections
• Knee deformity, such as bow-leg or knock-knee alignment

What is total knee replacement?

Total knee replacement is a well-established surgical procedure in which the damaged surfaces of the knee joint are removed and replaced with smooth, durable implants made from metal and medical-grade plastic.

The aim of surgery is to:

• Relieve pain
• Improve movement and stability
• Help you return to everyday activities

Is total knee replacement right for you?

You may be a suitable candidate if:

• Knee pain persists despite medication, injections or physiotherapy
• Stiffness makes walking, climbing stairs or standing difficult
• Pain affects sleep or daily life
• Arthritis has significantly reduced your quality of life

Mr Pavlou will take time to understand your symptoms, lifestyle and personal goals before recommending surgery.

A patient-focused approach to care

Choosing surgery is a major decision. From your first consultation through to recovery, care is centred around you.

This includes:

• Personalised treatment plans based on your needs and activity level
• Clear explanations so you know what to expect at every stage
• Individualised surgical planning
• Precision surgery using modern techniques
• An enhanced recovery programme to support rehabilitation
• A dedicated team supporting you before, during and after surgery

As a specialist knee surgeon, Mr Pavlou uses evidence-based techniques and a range of implant designs to achieve the best possible outcome for each patient.

What does the surgery involve?

Total knee replacement involves removing the damaged bone and cartilage from the knee joint and replacing it with artificial joint surfaces designed to move smoothly and reduce pain.

During surgery:

• You will receive anaesthesia so you do not feel pain
• Worn or damaged cartilage and bone are removed
• The knee is reshaped and fitted with an artificial joint
• The new joint is carefully aligned to restore movement and stability

The operation typically lasts 45 minutes to 2 hours, depending on complexity. Most patients begin gentle movement on the day of surgery and start walking with physiotherapy support. Some patients are discharged on the same day, while others require a short hospital stay for pain control and rehabilitation.

What to expect after surgery

It is normal for symptoms to temporarily worsen immediately after surgery due to swelling, bruising and the body’s response to the operation. Pain and stiffness are managed with medication, gentle exercise and swelling control measures such as ice therapy.

Swelling and bruising may make movement difficult in the early weeks. Cryotherapy and elevation are often helpful.

Most patients notice a significant improvement by around three months as healing progresses. While the knee may not be completely pain-free, daily activities usually become easier and more manageable.

Medium-term recovery is often characterised by gradual improvement, with some good days and some more difficult days. Full recovery can take 12–24 months, depending on individual factors.

Guided physiotherapy is essential to restore strength, flexibility and confidence. Many patients return to walking, driving and light exercise, and some go on to achieve higher levels of activity with motivation and rehabilitation.

Over time, patients commonly report:

• Reduced pain and stiffness
• Improved mobility and stability
• Greater independence and confidence

Following your recovery plan closely helps achieve the best possible outcome.

Understanding the benefits and risks

Benefits of total knee replacement

For many patients, knee replacement provides:

• Long-term pain relief
• Improved ability to walk, climb stairs and move comfortably
• Better sleep due to reduced pain
• Increased independence and confidence
• Long-lasting results, with many implants lasting 15–20 years or longer

Risks and possible complications

As with any major surgery, total knee replacement carries some risks. Serious complications are uncommon, but it is important to understand them.

Infection

You will be screened for bacteria, including MRSA, before surgery. Many hospitals provide pre-operative skin treatments to reduce infection risk. It is important that there are no cuts, wounds or grazes on your legs before surgery.

You may be advised to avoid activities such as gardening in the weeks before surgery. Weight management and smoking cessation are strongly encouraged, as both excess weight and smoking increase infection risk. If you are diabetic, strict control of blood sugars is advised before surgery. If you are taking immunosuppressive medication, you may be asked to stop this prior to the procedure.

Intravenous antibiotics are given during surgery, which takes place in advanced clean-air operating theatres.

Deep joint infection occurs in around 1–2% of patients. Superficial wound infections are more common and usually resolve with early treatment. Any wound concerns should be reported promptly. If deep infection is not treated early, revision surgery may be required.

Joint loosening

Knee replacements are mechanical devices and may wear out over time. Younger and more active patients have a higher chance of needing revision surgery later in life.

Approximately:

• 93% of knee replacements function well at 15 years
• 82% remain functional at 25 years

Stiffness

Stiffness may occur due to pain, swelling or scar tissue formation. Early movement and physiotherapy are essential to maximise knee motion. Rarely, a manipulation under anaesthetic may be required if progress is limited.

Fracture

Bone fractures during surgery are uncommon and usually minor. Most require no additional treatment, though plates or wires may occasionally be needed. Rarely, further surgery is required.

Nerve injury

Some numbness around the front of the knee is common and usually permanent but not problematic. Serious nerve injury is rare but can lead to weakness or altered sensation, which may recover over time or, rarely, be permanent.

Urinary problems

Temporary urinary retention or incontinence can occur, particularly in patients with pre-existing issues. These problems usually resolve quickly and are carefully managed.

Persistent pain

While knee replacement is highly effective, around 10% of patients may experience some ongoing discomfort. A smaller number remain dissatisfied despite technically successful surgery. Rarely, complex regional pain syndrome can develop.

Revision surgery

Occasionally further surgery is required due to:

• Infection
• Instability
• Stiffness
• Fracture
• Implant wear or loosening
• Malalignment
• Persistent symptoms

Medical complications

Medical risks include heart attack, stroke, pneumonia and, very rarely, death. These risks are carefully assessed and discussed during consultation. Every effort is made to minimise risks before, during and after surgery.

For further information about implant design, you may wish to read about the ATTUNE Knee System: View ATTUNE Knee System information

Choosing the right approach

Standard, patient-specific and robotic-assisted knee replacement are all tools that help deliver safe, personalised and high-quality care. Every patient is unique, but not every patient needs advanced technology. In selected cases, however, these approaches may improve precision and confidence in the result.

Mr Pavlou will help you choose the most appropriate approach based on your anatomy, symptoms and lifestyle. Living with knee pain does not have to be your normal. A consultation can help you understand your options and decide whether knee replacement surgery is right for you.